Arrhythmic mitral valve Prolapse (MIVAP) Predict Protocol: preliminary results

Abstract Background and Aim Mitral valve prolapse (MVP) is a common valve disease affecting 0.6-3.1% of the general population, occasionally leading to severe complications, including malignant ventricular arrhythmias and sudden cardiac death as the first clinical presentation. Identifying patients at high risk is a key step in a tailored diagnostic-therapeutic management. In this study, we prospectively explore the correlation between arrhythmic ventricular burden and histopathologically-detected inflammation in the excised valve of patients undergoing surgical correction of MVP. Methods Between october 2023 and april 2024, 35 patients underwent surgical correction of MVP at our Institution. Intraoperative specimens, including leaflet’s portion and/or myxomatous degeneration of the atrio-ventricular junction, were collected and histopathological examination performed. Primary endpoint of the study was the first occurrence of sustained ventricular arrhythmias, anti-tachycardia pacing (ATP) or shock, ventricular or supraventricular arrhythmic burden > 20%, re-admission for arrhythmic causes. Six months follow-up started after a blanking period of 60 days. Results Histopathological examination of mitral valve specimens revealed the presence of inflammatory cells in 15 (43%) patients. Adverse arrhythmic events were observed in 33% of the patients in the inflammation group vs 5% in the population without inflammation (p 0.04) as shown in Figure 1. Conclusion Histopathologically detected inflammation might be a significant factor increasing incidence of arrhythmias in patients undergoing surgical correction of MVP. Inflammation was associated with a higher incidence of adverse events, including sustained ventricular arrhythmias and hospital re-admissions. Our findings underscore the need for further investigation into the role of inflammation in MVP.